Consent of Occupant - Form B
I/We,
of
in the Province of Alberta, IN CONSIDERATION of the sum of $
dollars
paid to me (us) by the mineral producer/pipeline operator, receipt of which is hereby
acknowledged, and in consideration of the covenants and agreements hereinafter mentioned
and on the part of the mineral producer/pipeline operator to be kept, observed and performed:
I/We,
DO HEREBY CONSENT to the mineral producer/pipeline operator, its successors and assigns,
its contractors, subcontractors, servants and agents the right, license, liberty, privilege and
easement to enter upon, over, under and through all those portions of:
(the lands described in the lease, licence, permit) numbered
dated the
day of
,
, and made between Her Majesty the Queen in right of
the Province as represented by the Regulatory body (Minister of Environment and Sustainable
Resource Development or the Alberta Energy Regulator) as Lessor/Grantor and me (us) as
Lessee/Grantee at any time and from time to time with vehicles and equipment for the purposes
permitted by the Public Lands Administration Regulation and any regulations passed in
substitution therefor.
THE MINERAL PRODUCER/PIPELINE OPERATOR HEREBY COVENANTS AND
AGREES to compensate me (us) for damage done to my (our) buildings, growing crops, fences
and livestock on the said land by reason of the exercise of the rights hereby granted; and THE
MINERAL PRODUCER/PIPELINE OPERATOR HEREBY COVENANTS AND AGREES to pay
me (us), in addition to the consideration and compensation hereinbefore mentioned the annual
rent of $
dollars, such rent being payable annually in advance on the
day of
in each year or portion thereof that the rights hereby granted are exercised, the
first of which payments to be made on the
day of
, 20
.
If my (our) right to occupy the said land terminates for any reason, this consent and
covenants and agreements herein contained shall then and in that event cease and determine.
This consent is given under my (our) hand expressly for the purpose of satisfying the
requirements of Section 12 of the Surface Rights Act or any other relevant or applicable
legislation.
This consent shall be binding upon and shall enure to the benefit of my (our) heirs,
executors, administrators and assigns.
IN WITNESS WHEREOF I/WE, have executed this consent at
in the Province of Alberta, this
day of
, 20
.
SIGNED AND DELIVERED
OCCUPANT
By
In the presence of:
OCCUPANT
WITNESS
This Consent is hereby acknowledged and accepted by
the mineral producer/pipeline operator.
Per:
Dec 1, 2013
Consent of Occupant - Form B
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